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The Preference for Open vs Endovascular Repair of AAA (PROVE-AAA) Trial: Focusing on the Patient’s Preference for the Type of Repair The PROVE-AAA Study Team June 15 th , 2018
The Preference for Open vs Endovascular Repair of AAA (PROVE-AAA) Trial:
Focusing on the Patient’s Preference for the Type of Repair
The PROVE-AAA Study TeamJune 15th, 2018
DISCLOSUREPhilip Goodney
• No relevant financial relationship reported
Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times
Journal of Vascular Surgery 2018 67(6)
Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times
Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times
Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times
Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times
• Surgeons Like EVAR• Less Invasive• Lower operative
mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Like EVAR• Less Invasive• Lower operative
mortality
• Patients Like EVAR• Less Invasive• Lower operative
mortality
• Surgeons Like EVAR• Less Invasive• Lower operative
mortality
• Patients Like EVAR• Less Invasive• Lower operative
mortality
Device Brand A
Device Brand B
Years After Repair
10 Year Reintervention-Free Survival In VQI
ProportionSurviving
Free From Re-intervention
Device Brand A
Device Brand B
Years After Repair
10 Year Reintervention-Free Survival In VQI
ProportionSurviving
Free From Re-intervention 40% of Patients In VQI Needed
Reintervention by 10 years
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
• Surgeons Like EVAR• Less Invasive• Lower mortality
• Patients Like EVAR• Less Invasive• Lower mortality
• Surgeons Don’t Follow Patients• Costly• Burdensome
• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves
Decision Aids • Tools designed to help patients participate in
healthcare decisions
• Provide information on competing options
• Help patients clarify and communicate their values
Decision Aids • Medical Treatments
• Steroids vs. Biologics for Arthritis
• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint
disease
• Surgical Treatments
Decision Aids • Medical Treatments
• Steroids vs. Biologics for Arthritis
• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint
disease
• Surgical Treatments
Decision Aids • Medical Treatments
• Steroids vs. Biologics for Arthritis
• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint
disease
• Surgical Treatments
Options for Abdominal Aortic Aneurysm Repair
Open • Invasive• Longer recovery• Durable
Endovascular • Less invasive• Shorter recovery• Less durable
Study Objective• To implement a decision aid designed to help Veterans choose
between an open and endovascular repair for their AAA.
• To test if the decision aid makes it more likely for Veterans to receive the type of aneurysm repair that is align with their preference.
Study Objective• To implement a decision aid designed to help Veterans choose
between an open and endovascular repair for their AAA.
• To test if the decision aid makes it more likely for Veterans to receive the type of aneurysm repair that is align with their preference.
Veterans with Existing AAA
≥5.0 cmOpen/EVARCandidate
Veterans with Existing AAA
≥5.0 cmOpen/EVARCandidate
Control Sites (10 VA Hospitals):1. Repair Preferences Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Veterans with
Existing AAA
≥5.0 cm
Open/EVAR
Candidate
Control Sites (10 VA Hospitals):1. Repair Preferences Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Veterans with
Existing AAA
≥5.0 cm
Open/EVAR
Candidate
Control Sites (10 VA Hospitals):1. Repair Preferences Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Veterans with
Existing AAA
≥5.0 cm
Open/EVAR
Candidate
Control Sites (10 VA Hospitals):1. Repair Preferences Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*
2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Follow Veterans for Two Years to See What Happens When AAA Repair Occurs
Veterans with Existing AAA
≥5.0 cmOpen/EVARCandidate
Control Sites (10 VA Hospitals):1. Repair Preferences Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Main Outcome Measure:
Did Preferred AAA Repair Type = Actual Repair Type
Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score
Follow Veterans for Two Years to See What Happens When AAA Repair Occurs
Overall Study Goals• Identify factors associated with patient preference for open surgical
repair or EVAR for when facing treatment for AAA
• More broadly, help identify the best ways to help Veterans make the best decisions when facing surgery.
Overall Study Goals• Identify factors associated with patient preference for open surgical
repair or EVAR for when facing treatment for AAA
• More broadly, help identify the best ways to help patients make the best decisions when facing surgery.
Participating Sites
Participating Sites
PReferences for Open Versus Endovascular AAARepair Trial (PROVE-AAA)
VA HSR&D
PIs: Goodney, Ayra, Dosuoglu, Raffetto, Henke, Tang, Mureebee, Kougias, Zhou, Johanning, Scali, Stone, Orion,
Spangler, Tzeng, Halpern, Inhat, O’Connell, Brooke, Nelson, and Brewster
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15 0
20 0
25 0
May
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Jun-
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Aug-
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Sep-
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Oct
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Nov
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Dec-
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Jan-
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Feb-
18
Mar
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Apr -
18
May
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MONTHS OF ENROLLMENT
Projected Accrual Rate
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Enrollment Leaderboard
Summary • Patient preferences may play an important role in choosing between
open repair and EVAR.
• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.
• Our future work aims to test, whether the decision aid will improve alignment with Veteran preferences and their treatment.
Summary • Patient preferences may play an important role in choosing between
open repair and EVAR.
• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.
• Our future work aims to test, whether the decision aid will improve alignment with Veteran preferences and their treatment.
Summary • Patient preferences may play an important role in choosing between
open repair and EVAR.
• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.
• Our future work will help us decide if a decision aid will improve alignment with Veteran preferences and their treatment for AAA.
Thank You!
